title: The prognostic impact of variant histology in nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG).
abstract: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) accounts for approximately 5% of all Hodgkin lymphoma cases. The aim of this study was to evaluate the prognostic implication of histopathologic NLPHL variants. Biopsies of 423 NLPHL patients treated within 9 prospective clinical trials performed by the German Hodgkin Study Group were classified as tumor cell-rich cases (n = 10), typical NLPHL (n = 308), or histopathologic variants (n = 105). Histopathologic variants were characterized by the presence of lymphoma cells outside the B-cell nodules or B-cell depletion of the microenvironment. Compared with typical NLPHL, histopathologic variants were associated with advanced disease (29.5% vs 14.6%, P = .0012) and a higher relapse rate (18.1% vs 6.5% at 5 years, P = .0009). Variant histology represented an independent prognostic factor (odds ratio = 2.955) in a multivariate model of progression/relapse. A prognostic score, including the risk factors variant histopathologic growth pattern, low serum albumin, and male gender, was derived from this model and allowed the definition of 3 distinct risk groups. NLPHL patients presenting with histopathologic variants have a poorer outcome compared with those showing typical histology. The newly developed prognostic score combining histologic and clinical features allows allocating NLPHL patients to defined risk groups.
authors.affiliation: Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany;
authors.forename: Sylvia
authors.initials: S
authors.lastname: Hartmann
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Eichenauer
authors.forename: Annette
authors.initials: A
authors.lastname: Plütschow
authors.forename: Anja
authors.initials: A
authors.lastname: Mottok
authors.forename: Roshanak
authors.initials: R
authors.lastname: Bob
authors.forename: Karoline
authors.initials: K
authors.lastname: Koch
authors.forename: Heinz-Wolfram
authors.initials: HW
authors.lastname: Bernd
authors.forename: Sergio
authors.initials: S
authors.lastname: Cogliatti
authors.forename: Michael
authors.initials: M
authors.lastname: Hummel
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Feller
authors.forename: German
authors.initials: G
authors.lastname: Ott
authors.forename: Peter
authors.initials: P
authors.lastname: Möller
authors.forename: Andreas
authors.initials: A
authors.lastname: Rosenwald
authors.forename: Harald
authors.initials: H
authors.lastname: Stein
authors.forename: Martin-Leo
authors.initials: ML
authors.lastname: Hansmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Wolfram
authors.initials: W
authors.lastname: Klapper
mesh_terms: D000328:Adult; D001402:B-Lymphocytes / Q000473:pathology*; D016208:Databases, Factual; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006689:Hodgkin Disease / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors